• Referral Coord

    SSM Health (OK)


    It's more than a career, it's a calling.

    OK-REMOTE

    Worker Type:

    Regular

    Job Summary:

    Coordinates provider referrals, pre-certifications, and pre-authorizations for managed care insurance plans.

    Job Responsibilities and Requirements:

    PRIMARY RESPONSIBILITIES

    + Attends in-services provided by various health plans.

    + Travels to off-site locations as necessary.

    + Gathers necessary clinical information and processes referrals, pre-certification, pre-determinations, and pre-authorizes according to insurance plan requirements.

    + Logs, tracks and reviews managed care approvals and denials.

    + Responds in a timely manner to last minute/emergency referrals or additional codes performed during a procedure, or procedural changes for pre-authorizations.

    + Verifies insurance coverage, benefits and creatrs price estimates, reverifications as needed (ex; first of the month reverifications for managed Medicaid's).

    + Works collaboratively with insurance companies, providers and staff to ensure plan requirements have been met prior to patient services being rendered in order to maximize reimbursement.

    + Performs all other duties as assigned.

    EDUCATION

    + High School diploma/GED or 10 years of work experience

    EXPERIENCE

    + No experience required

    PHYSICAL REQUIREMENTS

    + Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.

    + Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.

    + Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.

    + Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.

    + Frequent keyboard use/data entry.

    + Occasional bending, stooping, kneeling, squatting, twisting and gripping.

    + Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.

    + Rare climbing.

    REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS

    + None

    Work Shift:

    Day Shift (United States of America)

    Job Type:

    Employee

    Department:

    7712020167 Medical Operations-0167

    Scheduled Weekly Hours:

    40

    Benefits:

    SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.

     

    + **Paid Parental Leave** **:** we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).

    + **Flexible Payment Options:** our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.

    + **Upfront Tuition Coverage** : we provide upfront tuition coverage through FlexPath Funded for eligible team members.

     

    Explore All Benefits (https://jobs.ssmhealth.com/us/en/benefits)

     

    _SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity,_ _pregnancy, veteran status_ **_,_** _or any other characteristic protected by applicable law. Click here to learn more. (https://www.ssmhealth.com/privacy-notices-terms-of-use/non-discrimination?\_ga=2.205881493.704955970.1667719643-240470506.1667719643)_